JP2010136990A - Endoscope system and aid - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To appropriately arrange an insertion portion of an aid in a position with respect to an insertion portion of a nasotracheal endoscope in accordance with the treatment. <P>SOLUTION: The insertion portion 35 of the aid includes an insertion portion body in which a forceps conduit is formed and an external cylinder 41 which is rotatably attached to the outer periphery of the insertion portion body and moves along the insertion portion body in the direction of the shaft of the insertion portion body. A restraining loop 45 is arranged on the outer surface of the insertion portion body near its end. The aid restrains and fixes the insertion portion 16 of the endoscope by changing the diameter of the restraining loop 45 by the movement of the external cylinder 41. The insertion portion 35 of the aid can be appropriately arranged in the insertion portion 16 of the endscope in a position in accordance with the treatment by adjusting the direction of the restraining loop 45 by rotating the insertion portion body and passing the insertion portion 16 through the restraining loop 45. <P>COPYRIGHT: (C)2010,JPO&INPIT

Description

  The present invention relates to an endoscope system that uses a combination of a nasal endoscope and an auxiliary tool that assists the function of the nasal endoscope.

  A so-called nasal endoscope is known in which an insertion portion formed in a flexible tubular shape is inserted from an outer nostril to inspect a body cavity of a subject (Patent Documents 1 and 2). Transnasal endoscopes enter the esophagus without touching the tongue base, so pharyngeal reflexes are less likely to occur than oral endoscopes where the insertion part is inserted through the mouth, and there is little nausea. The load on the person is low. In addition, transnasal endoscopes allow mouth breathing, less anesthetics than oral endoscopy, and subjects can talk to surgeons during the examination. In recent years, demand has increased.

  A transnasal endoscope is configured in the same way as an oral endoscope. In the internal space of the insertion section, forceps conduits for inserting various treatment instruments, air and water are inserted into the distal end surface of the observation optical system. (Observation window), an air / water supply conduit for feeding into the body cavity, a light guide for guiding the light supplied from the light source device and irradiating it from the tip as illumination light, and the like are housed.

  The transnasal endoscope passes through a narrow and winding insertion path from the outer nostril to the middle nasal passage (lower nasal passage), so the diameter of the insertion part of the oral endoscope is around 9 mm, whereas it is around 6 mm. And the diameter of the insertion part is thinner than the oral endoscope. For this reason, transnasal endoscopes have a narrower space for placing forceps ducts and the like provided in the insertion section than oral endoscopes, and these diameters can be reduced or any of them can be deleted. There is a problem of having to.

  If the diameter of the forceps conduit is reduced, the size of the treatment tool that can be used is limited, leading to a decrease in the amount of biopsy. The forceps conduit is also used as a suction conduit for sucking air, residue, body fluid, and the like accumulated in the body cavity. For this reason, when the diameter of the forceps conduit is reduced, the amount of suction is reduced and it takes time for suction. When the diameter of the air supply / water supply conduit is reduced, the flow rate per unit time of the air and water to be supplied decreases. For this reason, it takes time to expand the stomach to secure a visual field, and to wash away blood and mucus that disturb the observation. When the diameter of the light guide is reduced, the amount of illumination light is reduced and the background is darkened.

  As described above, the transnasal endoscope has an advantage that the load on the subject is low, but has a drawback that there are more functional restrictions than the oral endoscope. For this reason, in nasal endoscopy, when a lesion or the like that is difficult to treat with nasal endoscope is found, treatment must be performed by switching from nasal endoscope to oral endoscope. In some cases, there is a great demand for a transnasal endoscope that can perform the same level of treatment as an oral endoscope.

  As a proposal to meet these demands, a nasal endoscope is provided by using an auxiliary tool having a forceps conduit, a light guide, and the like, and having an insertion portion having the same diameter as that of a transnasal endoscope. It is conceivable to assist the function of the mirror. For example, if only the forceps conduit is provided in the insertion portion of the assisting device, the diameter of the forceps conduit is orally determined even if the diameter of the insertion portion is substantially the same as the insertion portion of the nasal endoscope. The diameter of the forceps conduit provided in the mirror can be made approximately the same. Therefore, the insertion part of the nasal endoscope is inserted from one outer nostril and the insertion part of the auxiliary tool is inserted from the other outer nostril. When performing the procedure, a biopsy amount equivalent to that of an oral endoscope can be obtained.

  Similarly, if an air supply / water supply conduit is provided at the insertion part of the auxiliary tool, the flow rate per unit time can be made the same level as that of an oral endoscope, and a light guide is provided at the insertion part of the auxiliary tool. If provided, the amount of illumination light can be made comparable to that of an oral endoscope. In this way, if an auxiliary tool is used in combination, a transnasal endoscope can perform the same level of treatment as an oral endoscope.

By the way, the position of the insertion part of the auxiliary tool with respect to the transnasal endoscope differs depending on the contents of the treatment. For example, when a treatment tool is inserted into each forceps conduit to perform a treatment (so-called double forceps), it is preferable to arrange the insertion portion of the auxiliary tool so that each treatment tool enters from both sides of the observation field. . In addition, when performing ESD (endoscopic submucosal dissection / peeling) using the forceps conduit of the auxiliary tool, the insertion part of the auxiliary tool is arranged so that the treatment tool enters from below the observation field of view. It is preferable. Further, when the forceps conduit of the auxiliary tool is used as the suction conduit, it is preferable to arrange the insertion portion of the auxiliary tool so that the opening of the forceps conduit is positioned below the observation field.
JP 2006-68030 A JP 2007-61377 A

  When using a combination of a nasal endoscope and an auxiliary tool, if each insertion part is separated, each must be operated individually, resulting in poor operability. For this reason, when performing a test combining both, after inserting each insertion portion from a separate nostril, treat the tip of each insertion portion within the body cavity of the subject (from the inner nostril to the esophagus) It is preferable to fix the position according to the content.

  However, when bleeding occurs due to treatment with a treatment tool, for example, there are cases where it is desired to change the content of the treatment during the examination, such as switching the forceps line to the suction line and sucking the blood that has been bleed. . In such a case, if each insertion part is fixed, each insertion part must be pulled out once and the fixing position of each insertion part must be adjusted, which is very troublesome and requires urgency such as bleeding In addition, there is a problem that it is impossible to respond quickly.

  The present invention has been made in view of the above problems, and when an inspection is performed by combining a nasal endoscope and an auxiliary tool, the insertion part of the auxiliary tool with respect to the insertion part of the nasal endoscope It is an object of the present invention to be able to appropriately arrange at a position corresponding to the treatment content, and to be able to respond quickly even when the treatment content changes during the examination.

  To achieve the above object, the present invention provides an endoscope having an insertion portion in which a forceps conduit for inserting a treatment instrument is formed, and a forceps conduit having a diameter larger than the forceps conduit of the endoscope An insertion tool having an insertion portion formed thereon, and inserting the insertion portion of the endoscope from one outer nostril and inserting the insertion portion of the auxiliary tool from the other outer nostril, In the endoscope system in which the function of the forceps conduit is supplemented by the assisting tool to perform the inspection, the insertion portion of the assisting tool is inserted into the insertion portion main body in which the forceps conduit is formed and the outer periphery of the insertion portion main body. And an outer cylindrical portion that is rotatably attached and moves in the axial direction of the insertion portion main body along the insertion portion main body, and the insertion portion of the endoscope is formed on the outer surface near the distal end of the insertion portion main body. An annular string body having a larger diameter is provided, and the string is formed by the movement of the outer cylinder portion. By changing the length of the portion exposed from the outer tube portion and changing the diameter of the string body accordingly, the distal end of the insertion portion of the endoscope becomes the distal end of the insertion portion of the auxiliary tool. It is characterized by being able to be restrained and fixed.

  It is preferable that the outer cylinder part has an inner diameter substantially the same as the outer diameter of the insertion part main body and is formed in a cylindrical shape shorter than the insertion part main body.

  The endoscope has a proximal operation portion that is connected to a proximal end portion of the insertion portion and performs a bending operation of the insertion portion, and the insertion portion of the auxiliary tool includes a proximal end portion thereof. It is preferable that a mounting portion is provided for detachably mounting to the hand operating portion. At this time, it is more preferable that the insertion portion of the auxiliary tool is connected to the attachment portion so as to be rotatable around an axis.

  In addition to the forceps conduit, the auxiliary tool is illumination means for illuminating the inside of the body cavity by illuminating illumination light, an air supply conduit for sending gas into the body cavity, and a liquid for sending liquid into the body cavity It is preferable to have at least one of the water supply pipelines.

  Further, the present invention has an insertion part in which a forceps conduit for inserting a treatment instrument is formed, and is used in combination with an endoscope for performing an inspection by inserting this insertion part from one outer nostril, The insertion portion has a forceps conduit having a diameter larger than that of the forceps conduit of the endoscope, and the insertion portion is inserted from the other nostril to assist the function of the forceps conduit of the endoscope. In the assisting tool, the insertion portion is attached to the insertion portion main body in which the forceps conduit is formed, and is rotatably attached to the outer periphery of the insertion portion main body, and the shaft of the insertion portion main body is arranged along the insertion portion main body. An annular string body having a larger diameter than the insertion portion of the endoscope is provided on the outer surface near the distal end of the insertion portion main body, and the outer cylinder portion is moved by moving the outer cylinder portion. The length of the part exposed from the outer cylinder part of the string body is changed, and the string is changed accordingly. By varying the diameter, characterized in that the distal end of the insertion portion of the endoscope and can be fixed by constraining the distal end of the insertion section of the assisting tool.

  In the present invention, a string body is provided on the insertion section main body that is rotatable with respect to the outer cylinder section, and the diameter of the string body is changed by the movement of the outer cylinder section, so that the distal end of the insertion section of the endoscope is attached to the auxiliary tool. The tip of the insertion part can be fixed and fixed. As a result, the cord body is rotated to adjust the direction of the cord body, and the insertion portion of the endoscope is passed through the cord body, so that the insertion portion of the auxiliary tool is treated as a treatment content with respect to the insertion portion of the endoscope. It can arrange | position appropriately according to the position.

  Further, in the present invention, it is possible to release the fixing of each insertion portion only by moving the outer cylinder portion, and it is possible to easily re-fix each insertion portion. Even in this case, it is possible to quickly respond to the treatment content after the change.

  As shown in FIG. 1, an endoscope system 10 includes an endoscope 11 that captures an image of a body cavity of a subject, an auxiliary tool 12 that assists the function of the endoscope 11, and illumination in the body cavity. The light source device 13 that supplies the illumination light to the endoscope 11, the processor device 14 that generates the endoscope image, and the monitor 15 that displays the endoscope image generated by the processor device 14. .

  The endoscope 11 includes an insertion portion 16 that is inserted into the body cavity of the subject, a hand operation portion 17 that is connected to the proximal end portion of the insertion portion 16 and that is operated by an operator such as a doctor, It has a universal cable 18 connected to the hand operation unit 17 and for connecting the endoscope 11 to the light source device 13 and the processor device 14. In addition, a forceps conduit 57 (see FIG. 3) for inserting various treatment tools such as forceps and snare from the hand operating section 17 to the distal end of the insertion section 16 is provided inside the endoscope 11. Is provided. The insertion portion 16 is formed in a tubular shape having an outer diameter of about 6 mm. The forceps conduit 57 is formed in a tubular shape having an inner diameter of about 2 mm.

  The auxiliary tool 12 includes an insertion portion 35 to be inserted into the body cavity of the subject, and an attachment portion 36 for attaching the proximal end portion of the insertion portion 35 to the hand operation portion 17 of the endoscope 11. Yes. The insertion portion 35 is formed in a tubular shape having an outer diameter that is substantially the same as or slightly thinner than the insertion portion 16 of the endoscope 11. A forceps conduit 74 (see FIG. 5) having a diameter larger than that of the forceps conduit 57 of the endoscope 11 is provided inside the auxiliary tool 12 from the attachment portion 36 to the distal end of the insertion portion 35. Yes.

  The endoscope 11 is a so-called transnasal endoscope that inserts the insertion portion 16 from the outer nostril. In the endoscope 11, the diameter of the insertion portion 16 is smaller than that of an oral endoscope in which the insertion portion is inserted from the mouth. Accordingly, the diameter of the forceps conduit 57 provided in the insertion portion 16 is naturally reduced. For this reason, in the endoscope 11, the size of the treatment tool that can be used is limited as compared with the oral endoscope.

  The endoscope system 10 inserts the insertion portion 16 of the endoscope 11 from one outer nostril, and inserts the insertion portion 35 of the auxiliary tool 12 from the other outer nostril where the insertion portion 16 of the endoscope 11 is not inserted. Are used in combination. Further, by assisting the function of the forceps conduit 57 of the endoscope 11 with the forceps conduit 74 of the assisting tool 12, even when performing inspection with the endoscope 11 which is a transnasal endoscope, the oral endoscope is used. Make it possible to use a treatment tool that is about the same size as a mirror. In addition, since the internal diameter of the forceps pipe line of a general oral endoscope is about 3.2 mm, it is preferable that the internal diameter of the forceps pipe line 74 of the auxiliary tool 12 is 3.2 mm or more.

  As is well known, the insertion portion 16 of the endoscope 11 includes a distal end hard portion 20, a bending portion 21, and a flexible portion 22. The distal end hard portion 20 incorporates an imaging element, an observation optical system, an illumination optical system, and the like inside a distal end main body formed of a hard metal material or the like.

  The bending portion 21 is configured to bend in four directions, up, down, left, and right in conjunction with operations of the up / down bending operation portion 23 and the left / right bending operation portion 24 provided in the hand operation portion 17. Thereby, the inside of the body cavity can be observed with the distal end surface of the distal end hard portion 20 directed in a desired direction. The soft part 22 is a part that connects the hand operating part 17 and the bending part 21, is formed in a thin and long tubular shape, and has flexibility.

  The bending direction of the bending portion 21 is defined in accordance with the direction of the endoscopic image displayed on the monitor 15 (the direction of the image sensor or the observation optical system arranged in the distal end hard portion 20). When the up / down bending operation unit 23 is operated to instruct upward bending, the endoscopic image displayed on the monitor 15 moves upward. When the downward bending operation unit 23 is operated to instruct downward bending, the endoscopic image displayed on the monitor 15 moves downward. When the right and left bending operation unit 24 is operated to instruct rightward bending, the endoscopic image displayed on the monitor 15 moves to the right. When the left / right bending operation unit 24 is operated to instruct leftward bending, the endoscopic image displayed on the monitor 15 moves to the left. As described above, the bending portion 21 is configured to bend in a direction corresponding to the display of the endoscopic image.

  In addition to the bending operation sections 23 and 24, the hand operation section 17 supplies air and water into the forceps inlet 25 for inserting the treatment tool into the forceps conduit 57, the observation window 62 and the body cavity. Air supply / water supply button 26 for performing the operation, suction button 27 for performing suction of air, residue, body fluid, etc. accumulated in the body cavity, and for injecting a liquid such as washing water or chemical liquid toward the observation target A water jet port (WJ port) 28 and the like are provided. A syringe is detachably connected to the WJ port 28. Washing water, chemicals, and the like that are sprayed onto the observation target are supplied from this syringe. Note that the forceps inlet 25 and the WJ port 28 are usually closed by a detachable stopper.

  The universal cable 18 includes a light guide connector (LG connector) 30 for connecting to the light source device 13 and a video connector (electrical) for connecting to the processor device 14 at the end opposite to the hand operating unit 17. Connector) 31 is provided. The electrical connector 31 is connected to the LG connector 30 via a cord 32. The endoscope 11 is detachably connected to the devices 13 and 14 via these connectors 30 and 31.

  Further, the LG connector 30 is connected to a joint for connecting a water supply tank 33 for storing water for water supply and a joint for connecting a suction device 34 for supplying suction pressure for suction to the endoscope 11. And are provided. The LG connector 30 is connected to the water supply tank 33 via a water supply joint and a water supply tube 33a, and is connected to the suction device 34 via a suction joint and a suction tube 34a.

  The suction joint is connected to a suction pipe formed in the endoscope 11. The suction line is connected to the forceps line 57 in the hand operation unit 17 and is closed by a valve that is interlocked with the pressing operation of the suction button 27. When the suction button 27 is pressed, the suction line is opened, and a path from the forceps line 57 to the suction device 34 via the suction line and the suction tube 34a is connected. When this path is connected, suction is started by the suction pressure of the suction device 34, and air, body fluid, and the like accumulated in the body cavity are sucked from the distal end of the insertion portion 16. Further, when the suction device 34 sucks a liquid such as washing water or body fluid, the liquid is stored in the suction tank 34b. As described above, the forceps conduit 57 also serves as a suction conduit.

  The light source device 13 has a built-in light source lamp that emits illumination light. The light source lamp is disposed so as to face the light incident surface of the connected LG connector 30 and makes illumination light incident on the light incident surface. Illumination light incident on the LG connector 30 is guided to an illumination optical system in the distal end hard portion 20 by a light guide provided in the endoscope 11, and an illumination window 63 disposed on the distal end surface of the distal end hard portion 20, 64 (see FIG. 4).

  Further, the light source device 13 is provided with a pump for supplying air for air supply / water supply to the endoscope 11. The air supplied from the light source device 13 is sent to the air supply conduit formed in the endoscope 11 via the LG connector 30 and also to the water supply tube 33a.

  In the water supply tube 33a, air supplied from the light source device 13 is supplied to the water supply tank 33 to apply pressure to the water supply tank 33, and water in the water supply tank 33 pushed out by the applied pressure. And a conduit for water supply. The water supply conduit is connected to a water supply conduit formed in the endoscope 11 by the LG connector 30.

  The air supply conduit and the water supply conduit of the endoscope 11 are closed by a valve that is interlocked with the pressing operation of the air / water supply button 26. In the center of the air / water supply button 26, a hole for leaking air supplied from the light source device 13 is provided. The valve switches between closing and opening of each pipe line in accordance with the pressing operation of the air / water supply button 26. When the hole of the air / water supply button 26 is closed with a finger, the air supplied from the light source device 13 is sent to the air supply pipe and discharged from the air / water supply nozzle 66 arranged at the tip of the insertion portion 16. When the air / water supply button 26 is pressed, the air supply line is closed, the water supply line is opened, and the water delivered from the water supply tank 33 is discharged from the air / water supply nozzle 66.

  It should be noted that the air supply conduit and the water supply conduit of the endoscope 11 are combined into one as an air supply / water supply conduit 58 (see FIG. 3) at a portion downstream of the valve. In the insertion portion 16, the air from the light source device 13 and the water from the water supply tank 33 are sent to the tip of the insertion portion 16 through the same air / water supply conduit 58.

  The processor device 14 is provided with an image processing circuit that performs various kinds of image processing on an imaging signal output from an imaging element provided in the endoscope 11 to generate an endoscopic image. The image processing circuit encodes the endoscopic image into a composite signal or RGB component signal and outputs the encoded signal to the monitor 15. Thereby, an endoscopic image is displayed on the monitor 15.

  As shown in FIG. 2, the insertion portion 35 of the auxiliary tool 12 includes an insertion portion main body 40 and an outer cylinder portion 41. The insertion portion main body 40 includes a distal end portion 42, a flexible portion 43, and a connection portion 44 in order from the distal end. The distal end portion 42 is formed of a hard material such as metal, like the distal end hard portion 20 of the endoscope 11. The flexible portion 43 is also configured in the same manner as the flexible portion 22 of the endoscope 11, is formed in a thin and long tubular shape, has flexibility, and has a distal end portion 42 and a connection portion 44. Connect between them. The connection part 44 connects the insertion part 35 to the attachment part 36. For example, a hard resin material is used for the connection portion 44.

  The outer cylinder portion 41 is formed in a cylindrical shape having an inner diameter substantially the same as the outer diameter of the insertion portion main body 40. The outer cylinder portion 41 is made of a resin material and has flexibility. Further, the outer cylinder portion 41 is formed shorter than the insertion portion main body 40. Accordingly, the outer cylinder portion 41 is rotatably attached to the outer periphery of the insertion portion main body 40 and moves in the axial direction of the insertion portion main body 40 along the insertion portion main body 40. In addition, the length of the outer cylinder part 41 should just be the length from which the rear end is exposed outside a body cavity, when the insertion part 35 is shorter than the insertion part main body 40 and it inserts in a body cavity.

  The insertion portion main body 40 is provided with a restraining loop (string body) 45 for restraining and fixing the distal end of the insertion portion 16 of the endoscope 11 to the distal end of the insertion portion 35 of the auxiliary tool 12. The restraining loop 45 is provided so as to protrude from the outer surface near the distal end of the insertion portion main body 40. The restraining loop 45 has a diameter larger than the diameter of the insertion portion 16 of the endoscope 11.

  Further, the restraining loop 45 is formed by rounding an elastic wire into an annular shape. As shown in FIG. 2, when the entire restraining loop 45 is exposed, the restraining loop 45 is substantially orthogonal to the axial direction of the insertion portion main body 40. And projecting in a direction to keep the ring inflated to prevent the diameter from constricting. Thereby, when the insertion part 16 is restrained, the insertion part 16 can be easily passed through the restraining loop 45.

  When the outer cylinder portion 41 is moved toward the distal end side from the state where the outer cylinder portion 41 is moved to the rear end side and the entire restriction loop 45 is exposed, the restriction loop 45 gradually becomes the outer cylinder portion. The diameter of the restraining loop 45 is reduced. As described above, the auxiliary tool 12 changes the length of the portion exposed from the outer tube portion 41 of the restraining loop 45 by the movement of the outer tube portion 41, and changes the diameter of the restraining loop 45 accordingly. As a result, the insertion portion 16 of the endoscope 11 is restrained.

  The attachment portion 36 includes a main body portion 46 formed in a substantially cylindrical shape, and a substantially cylindrical branch portion 47 formed so as to protrude substantially vertically from the vicinity of the center of the main body portion 46. It is formed in a three-pronged tube. The attachment portion 36 is connected to the connection portion 44 of the insertion portion 35 at the end portion of the branch portion 47. The connecting portion 44 is formed in a ring shape having an inner diameter substantially the same as the outer diameter of the branching portion 47. And the connection part 44 connects the insertion part 35 with respect to the attachment part 36 so that rotation is possible around an axis | shaft by fitting to the edge part of the branch part 47. FIG.

  One end 46a of the main body 46 has an inner diameter substantially the same as the outer diameter of the forceps inlet 25 formed in a substantially cylindrical shape. The attachment portion 36 is detachably attached to the hand operation portion 17 by fitting the end portion 46a to the forceps inlet 25. The other end 46 b of the main body 46 is a forceps inlet 48 for inserting a treatment tool into the forceps conduit 57 of the endoscope 11 and the forceps conduit 74 of the auxiliary tool 12.

  As described above, after the auxiliary tool 12 is attached to the forceps inlet 25 of the endoscope 11 by the attachment portion 36, the auxiliary tool 12 is endoscopically viewed through the forceps inlet 48 and the internal conduit of the attachment portion 36 formed in a trifurcated tubular shape. The treatment instrument can be selectively inserted into the forceps conduit 57 of the mirror 11 and the forceps conduit 74 of the auxiliary instrument 12. The forceps inlet 48 is formed in substantially the same shape as the forceps inlet 25 of the endoscope 11. Thereby, the forceps plug used for the forceps inlet 25 of the endoscope 11 can be attached to the forceps inlet 48.

  As described above, the forceps conduit 57 of the endoscope 11 also has a function as a suction conduit. When the auxiliary tool 12 is attached to the forceps inlet 25 and the suction button 27 is pressed, the forceps conduit 57 of the endoscope 11 and the forceps conduit 74 of the auxiliary tool 12 are attached via the attachment portion 36 formed in a trifurcated tube. Are connected to each other from the forceps conduits 57 and 74 at the same time. Thereby, when suction is performed using the auxiliary tool 12 in combination, the amount of suction per unit time can be increased.

  In addition, as timing which attaches the attachment part 36 of the auxiliary tool 12 to the forceps inlet 25, before insertion of each insertion part 16 and 35 in a body cavity, and after insertion can be considered. In this case, in the latter case, it is desirable that the length of the insertion portion 35 of the auxiliary tool 12 be longer than that of the insertion portion 16 of the endoscope 11 because the operation is easy.

  As shown in FIG. 3, the flexible portion 22 of the endoscope 11 includes a screw tube 50 called a flex that protects the inside while maintaining flexibility in order from the inside, and the outer layer 52 covered on the screw tube 50. It is composed of a flexible tube 53 consisting of three layers of a net 51 called a blade for holding a resin and an outer layer 52 on which the resin is deposited on the net 51.

  Inside the flexible tube 53, there are light guides 54, 55, an angle wire 56, a forceps conduit 57, an air / water supply conduit 58, a multicore cable 59, and a water jet conduit (WJ conduit) 60. Etc. are provided. The light guides 54 and 55 guide the illumination light supplied from the light source device 13 to the illumination optical system of the distal end hard portion 20. The angle wire 56 is configured such that two angle wires for up and down and left and right are respectively wound around two pulleys interlocking with the operation of the bending operation parts 23 and 24 and their tips are inserted toward the bending part 21. Therefore, there are four inside the flexible tube 53, and each of them is inserted into the tight coil pipe 56a.

  The forceps conduit 57 guides the treatment instrument inserted from the forceps inlet 25 or the forceps inlet 48 to the distal end hard portion 20. The air / water supply pipeline 58 sends air or water supplied to the distal end hard part 20 in response to the pressing operation of the air / water supply button 26. The multi-core cable 59 is a cable for mainly sending a signal for driving the imaging sensor from the video signal processing unit and sending an imaging signal obtained from the imaging sensor to the video signal processing unit. The cross-sectional shape is covered with a protective coating. The WJ conduit 60 sends liquid such as water and chemicals supplied from the syringe connected to the WJ port 28 to the hard tip portion 20.

  As shown in FIG. 4, an observation window 62, a pair of illumination windows 63 and 64, a forceps outlet 65, an air / water supply nozzle 66, and a water jet nozzle are provided on the distal end surface 20 a of the distal end hard portion 20 of the endoscope 11. (WJ nozzle) 67 and the like are provided. In the observation window 62, a part of an observation optical system for taking in image light from the observation object is arranged. The illumination windows 63 and 64 are provided on both sides of the observation window 62 and irradiate light from the light source device 13 supplied via the light guides 54 and 55 toward the observation target.

  The forceps outlet 65 leads the distal end of the treatment instrument inserted into the forceps conduit 57. The air supply / water supply nozzle 66 injects air or water sent from the air supply / water supply conduit 58 in response to the pressing operation of the air supply / water supply button 26. The injection port of the air / water supply nozzle 66 is formed so that the air and water to be injected are directed to the observation window 62. As a result, the observation window 62 is washed with the air or water jetted from the air / water feed nozzle 66, and dirt and the like adhering to the observation window 62 can be washed away. The WJ nozzle 67 ejects a liquid such as cleaning water or a chemical liquid sent from the WJ pipe line 60. The ejection port of the WJ nozzle 67 is formed in the direction of the optical axis of the observation window 62, and directly sprays the liquid to be ejected onto the observation target.

  As shown in FIG. 5, the flexible portion 43 of the assisting tool 12 is covered with a flexible tube 73 composed of three layers of a screw tube 70, a net 71, and an outer layer 72, similar to the flexible portion 22 of the endoscope 11. It has been broken. The screw tube 70 protects the inside while maintaining flexibility. The net 71 is covered on the screw tube 70 and holds the resin of the outer layer 72. The outer layer 72 is obtained by depositing a resin on the net 71.

  In the flexible tube 73, a forceps conduit 74 made of a synthetic resin flexible tube is provided. The forceps conduit 74 guides the treatment instrument inserted from the forceps inlet 48 to the distal end portion 42. Further, as shown in FIG. 6, a forceps outlet 76 for leading the distal end of the treatment instrument inserted into the forceps conduit 74 is formed on the distal end surface 42 a of the distal end portion 42.

  When the distal end of the insertion portion 16 of the endoscope 11 is fixed to the distal end of the insertion portion 35 of the auxiliary tool 12 using the restraining loop 45, as shown in FIG. After moving to the end side to expose the entire restraining loop 45, the insertion portions 16 and 35 are paralleled with the distal end surfaces 20a and 42a directed in the same direction, and the restraint provided on the insertion portion 35 Each is arranged so that the distal end surface 20a of the insertion portion 16 is located behind the loop 45 for use.

  When the insertion portions 16 and 35 are arranged, the insertion portion 16 is moved forward with respect to the insertion portion 35, and the insertion portion 16 is passed through the restraining loop 45. At this time, since the distal end surface 20a of the insertion portion 16 is positioned behind the restraining loop 45, the restraining loop 45 is displayed on the endoscopic image displayed on the monitor 15 (see FIG. 8). Thus, the operator can easily pass the insertion portion 16 through the restraining loop 45 by operating the insertion portions 16 and 35 while viewing the restraining loop 45 displayed in the endoscopic image.

  When the insertion portion 16 is passed through the restraining loop 45, the distal end surfaces 20a and 42a are aligned. And the insertion part 16 and the insertion part main body 40 are gripped, and the outer cylinder part 41 is moved to the front end side so that each front end surface 20a, 42a is not shifted. Then, the diameter of the restraining loop 45 is reduced, and the insertion portion 16 is restrained by the restraining loop 45 as shown in FIG. 7B, and the distal end of the insertion portion 16 is fixed to the distal end of the insertion portion 35.

  If the distal end of the insertion portion 16 is fixed to the distal end of the insertion portion 35 in this way, the flexible portion 43 of the insertion portion 35 bends following the bending of the bending portion 21 accompanying the bending operation of each bending operation portion 23, 24. The distal end surface 20a of the endoscope 11 and the distal end surface 42a of the auxiliary tool 12 are directed in the same direction. As a result, even when the endoscope 11 and the auxiliary tool 12 are used in combination, only the bending operation of the endoscope 11 is required, so that the operation can be prevented from becoming complicated.

  Further, when the distal end of the insertion portion 16 is fixed to the distal end of the insertion portion 35, the outer tubular portion 41 is gripped while the insertion portion main body 40 is rotated while observing the restraining loop 45 projected in the endoscopic image. By changing the direction in which the restraining loop 45 protrudes, the position of the insertion portion 35 relative to the insertion portion 16 can be easily changed.

  For example, when the insertion portion 35 is desired to be disposed on the lower side of the insertion portion 16 in the bending direction (the direction in which the bending portion 21 curves when the up / down bending operation portion 23 is operated to instruct downward bending). Then, the insertion portion main body 40 is rotated with respect to the attachment portion 36 and the outer cylinder portion 41 that are rotatably connected via the connection portion 44, and as shown in FIG. The restraining loop 45 protrudes upward in the screen with respect to the insertion portion main body 40.

  As described above, the bending direction of the bending portion 21 is defined in accordance with the direction of the endoscopic image displayed on the monitor 15. Therefore, if the direction of the restraining loop 45 is adjusted so as to protrude upward in the screen relative to the insertion portion main body 40 and the insertion portion 16 is passed through the restraining loop 45, the insertion portion 16 is inserted below the bending direction. The part 35 is arranged. Thereafter, the insertion portion 35 is fixed to the lower side in the bending direction of the insertion portion 16 by moving the outer cylinder portion 41 to the distal end side (see FIG. 9).

  Further, when the insertion portion 35 is to be arranged on the left side of the bending direction of the insertion portion 16 (the direction in which the bending portion 21 curves when the left and right bending operation portion 24 is operated to instruct leftward bending), As shown in FIG. 8B, the insertion portion main body 40 is rotated so that the restraining loop 45 projected in the endoscopic image 80 protrudes to the right of the screen with respect to the insertion portion main body 40. Then, the insertion portion 16 is passed through the restraining loop 45 and the outer cylinder portion 41 is moved to the distal end side, whereby the insertion portion 35 is fixed to the left side in the bending direction of the insertion portion 16 (see FIG. 13).

  Thus, in the endoscope system 10, the position of the insertion portion 35 relative to the insertion portion 16 can be easily changed by rotating the insertion portion main body 40 and changing the direction in which the restraining loop 45 protrudes. When adjusting the orientation of the restraining loop 45, the orientation of the restraining loop 45 is adjusted by rotating the insertion portion main body 40 provided on the inner side thereof without moving the outer cylinder portion 41 that is in direct contact with the nasal mucosa. Since it can be adjusted, the nasal mucous membrane is not stimulated by adjusting the direction of the restraining loop 45.

  The position of the insertion portion 35 of the auxiliary tool 12 relative to the insertion portion 16 of the endoscope 11 varies depending on the content of the treatment performed when the endoscope 11 and the auxiliary tool 12 are used in combination. For example, when performing ESD by inserting a high-frequency knife or the like into the forceps conduit 74 of the auxiliary tool 12, the insertion portion 35 is disposed below the observation window 62 as shown in FIG.

  When the insertion portion 35 is arranged as shown in FIG. 9, the high-frequency knife 82 enters the observation visual field from the lower side of the endoscopic image 80 as shown in FIG. In this way, the mucosa to be incised and the high-frequency knife 82 can be observed from above, and the insertion portion 16 of the endoscope 11 does not get in the way when the high-frequency knife 82 is moved left and right to incise the mucosa. So it is easy to treat.

  Further, when a treatment tool is inserted into each of the forceps conduit 57 of the endoscope 11 and the forceps conduit 74 of the auxiliary tool 12 to perform the treatment, as shown in FIG. The insertion portion 35 is disposed on the right side in the bending direction. When the insertion portion 35 is arranged in this way, as shown in FIG. 12, the forceps 84 led out from the forceps outlet 65 of the endoscope 11 and the forceps 86 led out from the forceps outlet 76 of the auxiliary tool 12 are Since it enters into an observation visual field from the both sides of the endoscopic image 80, each forceps 84 and 86 becomes easy to operate.

  When the treatment tools 84 and 86 are inserted into the forceps conduits 57 and 74 as described above, the attachment portion 36 is not attached to the forceps inlet 25, and the forceps 84 and 86 are inserted from both the forceps inlets 25 and 48. Insert.

  One of the types of endoscopes currently on the market is a so-called large forceps treatment endoscope having a forceps conduit having an inner diameter of about 3.8 mm. In such an endoscope for large forceps treatment, a forceps conduit is arranged on the left side in the bending direction with respect to the observation window. Therefore, when a large forceps treatment is performed using the forceps conduit 74 of the auxiliary tool 12, the insertion portion 35 is disposed on the left side in the bending direction with respect to the observation window 62 as shown in FIG. By doing so, it is possible to perform the operation without giving a sense of incongruity to the operator who is accustomed to the operation of the endoscope for existing large forceps treatment.

  Furthermore, in the case of performing suction using only the forceps conduit 74 of the auxiliary tool 12, the insertion part 35 of the auxiliary tool 12 is disposed on the lower side in the bending direction of the insertion part 16 of the endoscope 11 (see FIG. 9). ). In this way, the forceps outlet 76 of the insertion portion 35 can be brought close to the washing water or body fluid accumulated in the body cavity while observing with the endoscope 11 without the insertion portion 16 of the endoscope 11 being in the way. it can. Therefore, by arranging the insertion portion 35 as described above, the suction by the forceps conduit 74 of the auxiliary tool 12 can be efficiently performed.

  Next, the operation of the endoscope system 10 configured as described above will be described with reference to the flowchart shown in FIG. In the transnasal endoscopy, as a pretreatment, in order to insert the insertion part 16 of the endoscope 11, an anesthesia is performed from the nasal cavity of the nostril to the middle (lower) nasal passage and an insertion test is performed. The nasal cavity having an insertion path through which the unit 16 can be inserted is determined. The pretreatment is performed in the sitting position or the supine position, and thereafter, the insertion portion 16 is inserted into one outer nostril in the supine position or the left-side supine position. After being inserted from the outer nostril, the insertion unit 16 reaches the stomach or duodenum via the middle or lower nasal passage, the rear nostril (inner nostril), and the esophagus.

  When it is determined that treatment or treatment is not necessary by observing the duodenum or stomach, the insertion portion 16 of the endoscope 11 is pulled out from the body cavity and the examination is terminated. Further, when a lesion is found and treatment or treatment can be performed using the small-diameter forceps conduit 57 of the endoscope 11, a treatment such as a small snare or a biological forceps can be performed using the forceps conduit 57. A device is inserted for treatment or therapy.

  When it is determined that treatment or therapy cannot be performed in the forceps conduit 57 of the endoscope 11, the auxiliary tool 12 is used together. When the auxiliary tool 12 is used together with the endoscope 11, first, the insertion part 35 of the auxiliary tool 12 is inserted into the other nostril, so that the nasal cavity of the other nostril is anesthetized. Next, in order to fix the distal end of the insertion portion 16 of the endoscope 11 to the distal end of the insertion portion 35 of the auxiliary tool 12, the distal end surface 20a is positioned in the range from the rear nostril to the esophagus. The insertion part 16 is pulled back. Then, the insertion part 35 of the auxiliary tool 12 is inserted from the other outer nostril, and the distal end surface 42a is positioned in the range from the rear nostril to the esophagus.

  When the insertion portion 35 of the auxiliary tool 12 is inserted into the body cavity, the outer cylinder portion 41 is moved to the distal end side to prevent the restraining loop 45 from damaging the body wall. It is preferable that the entire restraining loop 45 be accommodated.

  After the insertion portions 16 and 35 are inserted, the outer cylinder portion 41 is moved to the rear end side, and the entire restraining loop 45 is exposed. Thereafter, while viewing the restraining loop 45 displayed in the endoscopic image 80, the insertion portion main body 40 is rotated with respect to the outer tubular portion 41, and the orientation of the restraining loop 45 is adjusted to a position corresponding to the treatment content. To do.

  When the direction of the restraining loop 45 is adjusted, the insertion portion 16 is moved forward, the insertion portion 16 is passed through the restraining loop 45, and the distal end surfaces 20a and 42a are aligned. Then, the outer cylinder portion 41 is moved to the distal end side to narrow the diameter of the restraining loop 45, and the distal end of the insertion portion 16 is restrained and fixed to the distal end of the insertion portion 35. As described above, in the endoscope system 10, the direction of the restraining loop 45 is adjusted, and the insertion portion 16 is passed through the restraining loop 45, whereby the insertion portion 35 of the auxiliary tool 12 is inserted into the insertion portion of the endoscope 11. 16 can be appropriately arranged at a position corresponding to the treatment content.

  When the insertion portions 16 and 35 are fixed, the attachment portion 36 of the auxiliary tool 12 is attached to the forceps inlet 25 of the endoscope 11 and insertion of the insertion portions 16 and 35 is started. When inserting the insertion sections 16 and 35, the bending operation sections 23 and 24 are operated while looking at the screen of the monitor 15, and insertion is performed while the bending section 21 of the endoscope 11 is bent. At this time, the flexible portion 43 of the assisting tool 12 is in close contact with the bending portion 21 of the endoscope 11 due to restraint by the restraining loop 45, and thus bends together with the bending portion 21 of the endoscope 11. Further, it is inserted following the insertion of the insertion portion 16 of the endoscope 11. Thereby, the insertion part 35 of the auxiliary tool 12 is also inserted together only by holding the insertion part 16 of the endoscope 11 and inserting it.

  When each of the insertion parts 16 and 35 is inserted and an affected part that needs to be treated or treated is displayed on the screen of the monitor 15, a treatment tool such as a snare or biopsy forceps is inserted into a forceps inlet provided in the attachment part 36. It is inserted from 48 into the forceps conduit 74 of the auxiliary tool 12. Then, the distal treatment member of the treatment tool, for example, a pair of forceps cups or a strangulation loop is led out from the forceps outlet 76 of the auxiliary tool 12 to perform treatment or treatment.

  A biopsy forceps described as an example of a treatment tool generally has an operation wire having a pair of forceps cups attached to the tip of the biopsy forceps so as to be freely opened and closed, and the rear end of the operation wire is positioned outside the forceps inlet. By moving forward and backward in the direction, the forceps cup is opened and closed in a hook shape by the link structure provided in the distal end portion of the flexible sheath. Biopsy forceps are mainly used for the purpose of tissue collection, and the inner diameter of a compatible forceps conduit often requires, for example, 2.8 mm or more.

  In addition, a snare is generally configured such that a strangulation loop formed by bending an elastic wire enters and exits from the sheath tip by operation from the proximal side of the sheath. In the state of being pulled in, it is elastically deformed into a constricted state, and when it is pushed forward from within the sheath, it expands into a loop-like shape. When polypectomy is performed with a snare, the root part of the polyp is properly tightened with a strut loop, and then a high-frequency current is applied to the strut loop to make contact with the strut loop. A part of living tissue is cauterized and cut and coagulated simultaneously. Many of these snares require an inner diameter of a compatible forceps conduit of, for example, 2.8 mm or more.

  Such a treatment tool such as a snare or biopsy forceps is used by using the forceps conduit 74 of the auxiliary tool 12, for example, tissue collection (biopsy) to remove the tissue, removal of foreign matter, bleeding stop, tumor removal, gallstone removal Treatment and treatment such as crushing. Further, when it is desired to aspirate internal dirt or blood or other body fluids, when the suction button 27 of the hand operation unit 17 is pressed, suction is performed not only from the forceps outlet 65 of the endoscope 11 but also from the forceps outlet 76 of the auxiliary tool 12. Therefore, rapid suction can be performed, and since suction from both forceps outlets 65 and 76 can be performed simultaneously, a large amount of living tissue can be collected.

  As described above, when the treatment content changes during the treatment using the forceps conduit 74 of the assisting tool 12, the outer tube portion 41 is moved to the rear end side and the insertion portion by the restraining loop 45 is inserted. Release 16 constraints once. Then, the direction of the restraining loop 45 is adjusted again according to the changed treatment content, and the insertion portion 16 is fixed again.

  For example, when the insertion portion 35 is disposed on the left side in the bending direction with respect to the observation window 62 (see FIG. 13) and the insertion portion 35 is used for large forceps, bleeding may occur unexpectedly. . In such a case, after the treatment instrument is pulled out from the forceps conduit 74, the insertion section 16 is fixed again, and the insertion section 35 of the auxiliary instrument 12 is disposed on the lower side in the bending direction of the insertion section 16 of the endoscope 11 (FIG. 9).

  In this way, while confirming the bleeding site with the endoscope 11, the bleeding blood is efficiently sucked using the forceps conduit 74 of the auxiliary tool 12 having a larger suction amount than the forceps conduit 57 of the endoscope 11. can do. As described above, in the endoscope system 10, the insertion portions 16 and 35 can be released by simply moving the outer cylinder portion 41 to the rear end side, and the insertion portions 16 and 35 can be fixed again. It can be done easily. Therefore, even when the treatment content changes during the examination, it is possible to quickly cope with the treatment content after the change.

  After the treatment or treatment is completed, the treatment tool is pulled out from the forceps inlet 48 of the auxiliary tool 12, and then both the insertion portions 16 and 35 are slowly pulled out. In the middle of this, for example, before passing through the range from the posterior nostril to the esophagus, the fixation of the distal ends of both insertion portions 16 and 35 is released. The fixation is released by moving the outer tube portion 41 to the rear end side to expand the diameter of the restraining loop 45 and then pulling out the insertion portion 16 from the restraining loop 45. After the fixing of the insertion portions 16 and 35 is released, the insertion portions 16 and 35 are individually pulled out in the order of the auxiliary tool 12 and the endoscope 11. Finally, the attachment part 36 of the auxiliary tool 12 is removed from the forceps inlet 25 of the hand operation part 17.

  By the above, the test | inspection at the time of using the endoscope 11 and the auxiliary tool 12 in combination is complete | finished. If it is known from the beginning that treatment or therapy cannot be performed using the forceps conduit 57 of the endoscope 11, the assisting tool 12 may be used from the beginning.

  In the above embodiment, the restraining loop 45 made of an elastic wire is shown as a string. However, the string is not limited to this, and for example, a strength that can be restrained, such as a resin thread or a thin metal wire. As long as it is a string-like thing which has, what kind of thing may be sufficient. However, when the string body is also narrowed when exposed from the outer cylinder portion 41, it is difficult to insert the insertion portion 16, and thus when exposed from the outer cylinder portion 41 as in the above-described restraining loop 45. It is preferable to have a configuration in which a state where the ring swells is maintained.

  In the above embodiment, when the insertion portion 16 of the endoscope 11 is passed through the restraining loop 45 and the distal end of the insertion portion 16 of the endoscope 11 is restrained and fixed to the distal end of the insertion portion 35 of the auxiliary tool 12, The outer cylinder portion 41 is moved in the axial direction. On the contrary, the insertion portion main body 40 may be moved in the axial direction while the position of the outer cylinder portion 41 is fixed. This makes it difficult to align the distal end surfaces 20a and 42a, but can suppress irritation in the nasal cavity associated with the movement of the outer cylinder portion 41. Moreover, not only one of the insertion part main body 40 and the outer cylinder part 41 may be fixed by moving both the insertion part main body 40 and the outer cylinder part 41.

  In the above embodiment, the forceps conduit 74 is provided in the auxiliary tool 12 to assist the function of the forceps conduit 57 of the endoscope 11. However, the present invention is not limited to this. For example, a light guide is provided in the auxiliary tool 12. It may be provided to assist the functions of the light guides 54 and 55 of the endoscope 11, or the air supply / water supply conduit 58 of the endoscope 11 may be provided by providing the auxiliary tool 12 with the air / water supply conduit 58. May be provided, or a WJ pipe line may be provided in the auxiliary tool 12 to assist the function of the WJ pipe line 60 of the endoscope 11. Furthermore, these may be combined and provided in the auxiliary tool 12 to assist a plurality of functions of the endoscope 11.

  In the endoscope 11 which is a transnasal endoscope, the diameters of the light guides 54 and 55 and the air / water supply conduit 58 are narrower than those of the oral endoscope as in the forceps conduit 57. Many transnasal endoscopes do not include the WJ duct 60 and the WJ nozzle 67. Reducing the diameters of the light guides 54 and 55 causes a decrease in the amount of illumination light and light distribution characteristics, and the distant view becomes dark. In addition, the reduction in the diameter of the air / water supply conduit 58 causes a decrease in the flow rate of air or water to be supplied per unit time, and it takes time to expand the stomach and clean blood and mucus. If the WJ pipe 60 is not provided, it is not possible to inject cleaning water or chemicals.

  Therefore, if a light guide is provided in the auxiliary tool 12, the amount of illumination light can be improved, and inspection can be performed with brightness and light distribution characteristics comparable to those of an oral endoscope. Further, if the auxiliary tool 12 is provided with an air supply / water supply conduit, the flow rate per unit time of the fluid to be fed can be made comparable to that of the oral endoscope. Furthermore, if the auxiliary tool 12 is provided with a WJ pipe, the liquid can be ejected as a water jet as in the case of the oral endoscope.

  In the above embodiment, the proximal end portion of the insertion portion 35 is detachably attached to the hand operation portion 17 of the endoscope 11 via the attachment portion 36. However, the present invention is not limited thereto, and the proximal end portion of the insertion portion is not limited thereto. It is good also as a structure which does not attach a part.

It is explanatory drawing which shows the structure of an endoscope system roughly. It is explanatory drawing which shows the structure of an auxiliary tool schematically. It is sectional drawing which shows schematically the structure in the soft part of an endoscope. It is a top view which shows roughly the structure of the front end surface of the insertion part of an endoscope. It is sectional drawing which shows schematically the structure in the soft part of an auxiliary tool. It is a top view which shows roughly the structure of the front end surface of the insertion part of an auxiliary tool. It is explanatory drawing which shows roughly the procedure at the time of fixing the front-end | tip of each insertion part. It is explanatory drawing which shows the state by which the loop for restraint was projected on the endoscopic image. It is explanatory drawing which shows the example which has arrange | positioned the insertion part of the auxiliary tool under the observation window. It is an example of the endoscopic image at the time of performing ESD. It is explanatory drawing which shows the example which has arrange | positioned the insertion part to the bending direction right side with respect to the observation window. It is an example of the endoscopic image at the time of performing a treatment with double forceps. It is explanatory drawing which shows the example which has arrange | positioned the insertion part to the bending direction left side with respect to the observation window. It is a flowchart which shows roughly the test | inspection procedure of an endoscope system.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10 Endoscope system 11 Endoscope 12 Auxiliary tool 16 Insertion part 17 Hand operation part 35 Insertion part 36 Attachment part 40 Insertion part main body 41 Outer cylinder part 44 Connection part 45 Restriction loop (string)
57 Forceps pipeline 74 Forceps pipeline

Claims (6)

An endoscope having an insertion portion in which a forceps conduit for inserting the treatment instrument is formed;
An auxiliary tool having an insertion portion in which a forceps conduit having a diameter larger than the forceps conduit of the endoscope is formed,
The insertion part of the endoscope is inserted from one outer nostril, the insertion part of the auxiliary tool is inserted from the other outer nostril, and the function of the forceps conduit of the endoscope is supplemented by the auxiliary tool. In an endoscope system that performs
An insertion portion of the auxiliary tool is rotatably attached to an insertion portion main body in which the forceps conduit is formed, and an outer periphery of the insertion portion main body, and along the insertion portion main body in the axial direction of the insertion portion main body. It consists of a moving outer cylinder part,
On the outer surface near the distal end of the insertion portion main body, an annular string body having a larger diameter than the insertion portion of the endoscope is provided,
The distal end of the insertion portion of the endoscope is changed by changing the length of the portion exposed from the outer tube portion of the string body by moving the outer tube portion and changing the diameter of the string body accordingly. An endoscope system characterized in that can be fixed by being restrained at the distal end of the insertion portion of the auxiliary tool.   The endoscope according to claim 1, wherein the outer cylinder part has an inner diameter substantially the same as an outer diameter of the insertion part main body, and is formed in a cylindrical shape shorter than the insertion part main body. system. The endoscope has a hand operation part that is connected to a base end part of the insertion part and performs a bending operation of the insertion part,
The endoscope system according to claim 1 or 2, wherein the insertion portion of the auxiliary tool is provided with an attachment portion for detachably attaching the proximal end portion to the hand operation portion.   The endoscope system according to claim 3, wherein the insertion portion of the auxiliary tool is connected to the attachment portion so as to be rotatable about an axis.   In addition to the forceps conduit, the auxiliary tool is illumination means for illuminating the inside of the body cavity by illuminating illumination light, an air supply conduit for sending gas into the body cavity, and a liquid for sending liquid into the body cavity The endoscope system according to any one of claims 1 to 4, wherein the endoscope system includes at least one of water supply pipelines. It has an insertion part in which a forceps conduit for inserting the treatment tool is formed, and is used in combination with an endoscope for performing an examination by inserting this insertion part from one outer nostril,
The insertion portion has a forceps conduit having a diameter larger than that of the forceps conduit of the endoscope, and the insertion portion is inserted from the other nostril to assist the function of the forceps conduit of the endoscope. In the assisting tool,
The insertion portion includes an insertion portion main body in which the forceps conduit is formed, and an outer portion that is rotatably attached to the outer periphery of the insertion portion main body and moves in the axial direction of the insertion portion main body along the insertion portion main body. It consists of a cylinder part,
On the outer surface near the distal end of the insertion portion main body, an annular string body having a larger diameter than the insertion portion of the endoscope is provided,
The distal end of the insertion portion of the endoscope is changed by changing the length of the portion exposed from the outer tube portion of the string body by moving the outer tube portion and changing the diameter of the string body accordingly. An auxiliary tool characterized in that it can be fixed by being restrained at the tip of the insertion part of the auxiliary tool.

Images